Citation Nr: 0303576
Decision Date: 03/03/03 Archive Date: 03/18/03
DOCKET NO. 95-27 671 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Muskogee,
Oklahoma
THE ISSUE
Entitlement to an initial disability evaluation in excess of
30 percent for scalp folliculitis, acne keloidalis nuchae,
and hidradenitis suppurativa.
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESSES AT HEARING ON APPEAL
Appellant, Appellant's husband
ATTORNEY FOR THE BOARD
Hallie E. Brokowsky, Associate Counsel
INTRODUCTION
The veteran had active service from May 1989 to August 1992.
This matter comes before the Board of Veterans' Appeals (BVA
or Board) on appeal from rating decisions of the Department
of Veterans Affairs (VA) Regional Office in Seattle,
Washington and Muskogee, Oklahoma (RO). The Seattle,
Washington RO granted service connection for the veteran's
skin disorder and assigned a 10 percent disability evaluation
effective May 1994. The veteran's claims file was
subsequently transferred to the Muskogee, Oklahoma RO,
wherein she was granted a 30 percent disability evaluation
for her skin disorder, also effective May 1994.
In a December 2000 decision, the Board denied the veteran's
claim for an initial disability evaluation in excess of 30
percent for her skin disorder. The veteran appealed that
decision to the United States Court of Appeals for Veterans
Claims (Court). In January 2002, the Court vacated the
December 2000 Board decision with respect to the issue
presently on appeal, and remanded the matter back to the
Board for development consistent with the Joint Motion for
Remand and to Stay Proceedings (Motion). The veteran's
appeal was returned to the Board for additional development,
consideration of the Veterans Claims Assistance Act of 2000,
and readjudication.
The Board observes that the December 2000 Board decision also
remanded the issues of service connection for anemia and
entitlement to an increased disability evaluation for
cholelithiasis. These issues were not addressed by the Court
and are not presently before the Board. As such, these
issues are still pending before the RO.
FINDINGS OF FACT
1. The veteran was notified of the evidence needed to
substantiate her claim, and all relevant evidence necessary
for an equitable disposition of this appeal has been
obtained.
2. From May 16, 1994 to August 29, 2002, the veteran's skin
disorder was manifested by repeated ulceration and
exceptional repugnancy.
3. Since August 30, 2002, the veteran's skin disorder
required near constant systemic therapy of corticosteroids
and immunosuppressants, as it had for the previous year.
CONCLUSION OF LAW
1. The criteria for an initial disability evaluation of 50
percent for scalp folliculitis, acne keloidalis nuchae, and
hidradenitis, for the period from May 16, 1994 to August 29,
2002, have been met. 38 U.S.C.A. §§ 1155, 5103A, 5107(b)
(West 1991 & Supp. 2001); 66 Fed. Reg. 45,620, 45,630-32
(Aug. 29, 2001) (to be codified as amended at 38 C.F.R.
§§ 3.102, 3.159); 38 C.F.R. §§ 3.321, 4.1-4.14, 4.118,
Diagnostic Code 7806 (2001); 67 Fed. Reg. 49,590, 49,596
(July 31, 2002).
2. The criteria for a disability evaluation of 60 percent
for scalp folliculitis, acne keloidalis nuchae, and
hidradenitis, for the period from August 30, 2002, have been
met. 38 U.S.C.A. §§ 1155, 5103A, 5107(b) (West 1991 & Supp.
2001); 66 Fed. Reg. 45,620, 45,630-32 (Aug. 29, 2001) (to be
codified as amended at 38 C.F.R. §§ 3.102, 3.159); 38 C.F.R.
§§ 3.321, 4.1-4.14, 4.118, Diagnostic Code 7806 (2001); 67
Fed. Reg. 49,590, 49,596 (July 31, 2002).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
The veteran essentially contends that the current disability
evaluation assigned for her skin disorder does not accurately
reflect the severity of that disability. Specifically, the
veteran asserts that her disorder should be assigned an
increased disability evaluation because she experiences
recurrent cysts and lesions, drainage, and scarring.
As a preliminary matter, in November 2000, the Veterans
Claims Assistance Act of 2000 (VCAA) became law. The VCAA
applies to all claims for VA benefits and provides, among
other things, that the VA shall make reasonable efforts to
notify a claimant of the evidence necessary to substantiate a
claim for benefits under laws administered by the VA. The
VCAA also requires the VA to assist a claimant in obtaining
that evidence. See 38 U.S.C.A. §§ 5103, 5103A (West Supp.
2001); 66 Fed. Reg. 45, 630 (Aug. 29, 2001) (to be codified
at 38 C.F.R. § 3.159).
First, the VA has a duty under the VCAA to notify the veteran
and her representative of any information and evidence needed
to substantiate and complete her claim. The rating
decisions, the statement of the case, and the supplemental
statements of the case issued in connection with the
veteran's appeal, as well as additional correspondence to the
veteran, have notified her of the evidence considered, the
pertinent laws and regulations, and the reason that her claim
was denied. The RO indicated that they would review the
information of record and determine what additional
information is needed to process the veteran's claim. The RO
also informed the veteran of what the evidence must show in
order to warrant entitlement to an increased disability
evaluation and provided a detailed explanation of why an
increased rating was not granted. In addition, the statement
of the case and the supplemental statements of the case
included the criteria for granting an increased rating for
her skin disorder, as well as other regulations pertaining to
her claim for an increased evaluation. Letters to the
veteran, from the RO, notified the veteran as to what kind of
information they needed from her, and what she could do to
help her claim. Likewise, a December 2002 letter from the
Board apprised the veteran of a change in the regulations
regarding skin disorders and notified her that she could
submit additional evidence regarding her claim. The veteran
was also provided a copy of the revised regulations. See
Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002)
(requiring VA to notify the veteran of what evidence he was
required to provide and what evidence the VA would attempt to
obtain). Under the circumstances, the Board finds that the
notification requirements of the VCAA have been satisfied.
Second, the VA has a duty to assist the veteran in obtaining
evidence necessary to substantiate her claim. In this
regard, the veteran's service medical records, military
medical records, and VA medical records have been obtained.
In addition, the veteran was afforded several VA examinations
and a hearing before the RO. The veteran and her
representative have not made the Board aware of any
additional evidence that should be obtained prior to
appellate review, and the Board is satisfied that the
requirements under the VCAA have been met. As such, the
Board finds that the duty to assist was satisfied and the
case is ready for appellate review. See Bernard v. Brown, 4
Vet. App. 384, 392-394 (1993). See also VAOPGCPREC 16-92.
Disability ratings are determined by evaluating the extent to
which a veteran's service-connected disability adversely
affects his or her ability to function under the ordinary
conditions of daily life, including employment, by comparing
his or her symptomatology with the criteria set forth in the
Schedule for Rating Disabilities. See 38 U.S.C.A. § 1155;
38 C.F.R. § 4.1. If two ratings are potentially applicable,
the higher rating will be assigned if the disability more
nearly approximates the criteria required for that rating;
otherwise, the lower rating will be assigned. See 38 C.F.R.
§ 4.7. Any reasonable doubt regarding the degree of
disability will be resolved in favor of the veteran. See
38 C.F.R. § 4.3.
Furthermore, a disability rating may require re-evaluation in
accordance with changes in a veteran's condition. Thus, it
is essential that the disability be considered in the context
of the entire recorded history when determining the level of
current impairment. See 38 C.F.R. § 4.1. In addition, where
an award of service connection for a disability has been
granted and the assignment of an initial evaluation for that
disability is disputed, separate evaluations may be assigned
for separate periods of time based on the facts found. In
other words, evaluations may be "staged." See Fenderson v.
West, 12 Vet. App. 119, 126 (1999). In this case, the issue
of an increased evaluation for dermatitis stems from an
initial grant of service connection and the assignment of a
30 percent disability evaluation.
Historically, a September 1994 rating decision granted the
veteran service connection for multiple cysts, and assigned a
noncompensable disability evaluation effective May 16, 1994.
The veteran submitted a notice of disagreement in May 1995,
the RO issued a statement of the case in June 1995, and the
veteran perfected her appeal. Following the submission of
additional medical evidence, the RO, in a January 1997 rating
decision, increased the veteran's disability evaluation to 10
percent disabling, also effective May 1994. The veteran
filed a notice of disagreement with the 10 percent disability
evaluation in November 1997 and, after the submission of
additional medical evidence, the RO increased the disability
evaluation for the veteran's skin disorder to 30 percent,
again effective May 1994. As discussed in the Introduction,
the Board denied the veteran's claim for an increased
disability evaluation in a December 2000 decision, which was
vacated and remanded with regard to that issue by the Court
in January 2002. Following additional development, the
veteran's claim is again before the Board.
According to the September 1994 rating decision, service
connection was granted on the basis that the veteran's
service medical records showed treatment for a right thigh
abscess in October 1989, an infected right thigh cyst in
November 1989, a fistula in ano in May 1990, and folliculitis
of the scalp in January 1991; a VA examination which showed
cysts on the scalp, right axillary area, right groin, and
perivaginal area; and a two year history of recurrent cysts
on various body parts.
An August 1992 military medical record (when the veteran was
a dependent of a member of the military), states that the
veteran complained of crusting sores on her scalp and sores
on the right inguinal area. The assessment was seborrheic
dermatitis/folliculitis. Keflex and Selsun shampoo were
prescribed.
In October 1993 she was treated for a cyst in the right
axilla with moderate purulent exudate.
A December 1993 VA medical record states that the veteran had
moderate to severe acne of the face, multiple areas of
folliculitis (scalp, mons pubis, and right axilla), and
spontaneous, purulent drainage of the right axilla
folliculitis. A fever was suspected to be secondary to the
veteran's folliculitis. Keflex was increased.
In March 1994, the veteran had an aspiration of yellow puss
from an inguinal lesion. She was also treated for
folliculitis of the scalp and acne. At the time, examination
showed multiple pustular lesions around the hair shafts.
Rimantadine was prescribed.
In May 1994, the veteran was noted as having hidradenitis,
requiring use of dicloxacillin.
In June 1994, the veteran was treated for draining cysts of
the left groin and right axilla with healed hidradenitis.
Dicloxacillin was prescribed. Another June 1994 VA medical
record shows that a right thigh abscess was aspirated.
According to the aforementioned June 1994 VA examination, the
veteran reported that she had recurrent cysts throughout her
body, extending from the scalp area to the perivaginal rectal
area and thighs. She also reported that these cysts have
"come and gone" and required multiple incisions and
drainage. Examination showed cysts throughout the back of
her scalp, a chronic cyst of the right axillary area, and a
tender cyst in the right groin. The veteran also had a cyst
in the perivaginal area. The diagnosis was recurrent large
cysts involving the scalp, axillary areas, and inguinal
areas.
An August 1995, the veteran was noted as having Grade III
cystic acne, without response to erythromycin or retin-a.
In November 1995, the veteran was treated for facial acne and
lesions of buttocks and vaginal area. Tetracycline and
retin-a were noted as helping, but were discontinued.
An undated treatment note shows that the veteran had papular
lesions of the rectal area, multiple hyperpigmented areas of
the face, and a cystic inflammation on each buttock. The
assessment was acne/folliculitis. Retin-a and doxycycline
were prescribed.
In March 1996, examination showed greasy, moderately thick
scaling of the scalp, with pustules along the hairline, and
hyperpigmented macules of the cheek and forehead. The
assessment was acne/folliculitis, improved, and seborrheic
dermatitis.
A July 1996 VA treatment note shows that the veteran's acne
improved with the doxycycline and retin-a. Examination
showed that the veteran did not have any pustules, but did
have some healing papular lesions and small areas of
hyperpigmentation. Her scalp had decreased thick scaling.
The assessment was improved acne and seborrheic dermatitis.
In May 1997, the veteran was treated for chronic, painful
sores on the back of her head and small pustules on her face.
Doxycycline and Nizoral shampoo were prescribed.
A November 1997 VA medical record shows that the veteran
complained that the sores on her head had been bleeding.
Examination showed folliculitis of the scalp, with a possible
infection.
A December 1997 VA treatment record indicates that the
veteran was diagnosed with folliculitis of the scalp
following complaints of lesions and cysts on the scalp.
Keflex was prescribed as the veteran was unable to take
erythromycin or dicloxacillin. Another record states that
she had a chronic subcutaneous cyst in the right upper thigh,
which was not spontaneously draining. Warm compresses and
treatment of her symptoms was recommended.
The veteran was afforded another VA examination in January
1998. According to the report, the veteran complained of
chronic sores on her scalp and occasional flare-up of sores
in her pubic area. The veteran reported that she had been
treated with multiple courses of antibiotics, with temporary
relief, and shampoos, which have not helped. The examination
showed scattered follicular papules and pustules of the
central scalp, scattered scars similar to follicular papules
on the posterior scalp and neck, and scattered comedones,
papules, and macules of hyperpigmentation on the face. She
also had follicular papules and subcutaneous small nodules on
the medial thighs and labia majora, as well as scarring on
the medial thighs in a follicular pattern. The assessment
was chronic scalp folliculitis, acne keloidalis nuchae of the
posterior scalp and neck, moderate inflammatory facial acne,
and hidradenitis suppurativa of the medial thighs. The
examiner noted that these problems were chronic and could
only be partially controlled. The examiner prescribed a
topical Cleocin solution, topical flucinanite, and oral
antibiotics.
A March 1998 VA medical record states that an examination of
the veteran showed follicular papules and crusting on the
veteran's occipital scalp. The assessment was acne keloidal
nuchae. Several medications were prescribed, including
betamethasone ointment.
The veteran was afforded a hearing before the RO in June
1998. According to the transcript, the veteran testified
that she had cysts on her buttocks, vaginal area, and on her
head. She stated that the cysts on her head bleed and cause
headaches, and that the shampoos used to treat her disorder
caused hair loss. She also stated that the cysts itch, but
that she did not have daily itching. She also testified that
she had some of her cysts surgically removed and others were
surgically aspirated. In addition, the veteran reported that
she had taken antibiotics for her cysts, but that the doctors
preferred not to do so anymore, as it was causing her stomach
upset. She also reported that she used steroids for
treatment, and that the surgical removal and aspiration of
her cysts had left many scars. The veteran also related that
her skin disorder was chronic.
An October 1998 VA medical record listed the veteran's
medications as: betamethasone ointment, selenium sulfide
lotion/shampoo, fluocinolone topical solution, clindamycin
topical solution, famotidine tablet, and tretinoin cream. A
treatment addendum indicates that the veteran had lesions on
her labia, which were open, but not draining.
A March 2000 VA treatment record states that the veteran had
hyperpigmented macular lesions of the left arm.
A July 2000 VA medical record notes a history of seborrheic
dermatitis and acne. She was treated for a small excoriation
of the perianal area.
A March 2001 VA treatment note states that the veteran had
severe inflammatory acne lesions on her face, with scarring.
Another March 2001 treatment note indicates that the veteran
had lesions on her scalp, and that she was to restart her
shampoo and steroid cream.
A February 2002 VA medical record shows that the veteran had
acne vulgaris and seborrheic dermatitis. In addition, she
was treated for a rectal lesion with surrounding erythema and
white discharge. There were no ulcerations. Medications
included: benzoyl peroxide 5/erythmomycin gel; betamethasone
valerate aerosol; clindamycin phosphate topical solution;
fluocinolone acetonide topical solution; hydroquinone cream;
minocycline capsules; salicylic acid/sulfur shampoo; selenium
sulfide lotion/shampoo; tretinoin cream; and triamcinolone
acetonide cream.
A July 2002 VA treatment note indicates that the veteran had
a pilonidal cyst on the left superior gluteal fold with
excoriation and discharge. Another July 2002 treatment note
indicates that the veteran complained that her medications
were not working.
An August 2002 VA "order summary" indicates that the
veteran had been prescribed various creams, ointments,
tablets, shampoos since July 1996 for her skin disorder, most
with instructions to use daily.
The veteran was most recently afforded a VA examination in
September 2002. The report indicates that the veteran
reported a long history of "breaking out" on her scalp,
axilla, groin, and perianal area. She also reported that she
had been treated with numerous medications, but only had
minimal relief. Upon examination, she had hyperkeratotic
papules and nodules in the posterior scalp; hyperpigmentation
and nodules on the forehead, cheeks, and neck; and scarring
and sinus tracts in the axilla. There was no evidence of
drainage in these areas. Her buttocks and gluteal cleft had
numerous, tender firm nodules. She also had a fissure in the
gluteal cleft, with purulent discharge and erythema. There
was extensive scarring of the vaginal area, with sinus
tracts, hyperpigmentation, and nodules. There were also
numerous sinus tracts and ulcerations in the gluteal cleft.
There were many fissures and tracts in the veteran's groin
and buttock areas, with scarring and tenderness. The
examiner characterized the scarring on the veteran's
posterior scalp, axilla, and groin as "exceptionally
repugnant" and noted that the scars on the veteran's axilla
and groin were tender. There were color irregularities noted
on the veteran's face and neck. The impression was acne
keloidalis, under fair control and hidrosadenitis
suppurativa, active in the groin and buttock areas. The
examiner also noted that the veteran's axilla was not
actively involved at that time. The examiner stated that the
veteran's hidrosadenitis suppurativa was a systemic disease,
which will "wax and wane" in severity for the veteran's
lifetime, requiring continuous treatment. The examiner also
stated that alopecia and pigment changes were a part of her
acne and pseudofolliculitis, "which have systemic and
nervous manifestations."
A January 2003 VA medical record noted that the veteran was
prescribed nine medications for her skin disorder. The
record also indicated that the veteran was treated for a
right buttock lesion and a lesion on the left gluteal cheek
with a small draining fistula. The assessment was pilonidal
cyst. Antibiotics were prescribed.
The RO assigned a 30 percent disability evaluation for the
veteran's skin disorder by analogy to 38 C.F.R. § 4.118,
Diagnostic Code 7806. When an unlisted condition is
encountered it will be permissible to rate under a closely
related disease or injury in which not only the functions
affected, but also the anatomical localization and
symptomatology are closely analogous. See 38 C.F.R. § 4.20
(2002).
The Board notes that after the veteran initiated this appeal,
the regulations pertaining to the evaluation of skin
disorders were amended, effective
August 30, 2002. See 67 Fed. Reg. 49,590 (2002). "[W]here
the law or regulation changes after a claim has been filed or
reopened but before . . . the appeal process has been
concluded, the version most favorable to the appellant should
and . . . will apply unless Congress provided otherwise or
permitted the Secretary of Veterans Affairs (Secretary) to do
otherwise and the Secretary did so." Karnas v. Derwinski, 1
Vet. App. 308, 312-313 (1991). However, where the amended
regulations expressly provide an effective date and do not
allow for retroactive application, the veteran is not
entitled to consideration of the amended regulations prior to
the established effective date. See Green v. Brown, 10 Vet.
App. 111, 116-119 (1997); see also 38 U.S.C.A. § 5110(g)
(West 1991 & Supp. 2001). Therefore, the Board must evaluate
the appellant's claim for an increased rating under both the
old criteria in the VA Schedule for Rating Disabilities and
the current regulations in order to ascertain which version
is most favorable to his claim, if indeed one is more
favorable than the other. For any date prior to August 30,
2002, the Board cannot apply the revised regulations.
Under the former version of Diagnostic Code 7806, a 30
percent disability evaluation was assigned under this Code
for eczema with constant exudation or itching, extensive
lesions, or marked disfigurement. See 38 C.F.R. § 4.118,
Diagnostic Code 7806. A 50 percent disability evaluation was
warranted for eczema with ulceration or extensive exfoliation
or crusting, and systemic or nervous manifestations, or for
exceptionally repugnant eczema. Id. The Board observes that
there is no higher disability evaluation under this Code.
According to the current regulations, effective August 30,
2002, the veteran's disorder continues to be evaluated under
38 C.F.R. § 4.118, Diagnostic Code 7806, which is now used
for rating dermatitis in addition to eczema. A 30 percent
disability evaluation is assigned for dermatitis or eczema
over 20 to 40 percent of the body or 20 to 40 percent of the
affected exposed areas, or systemic therapy, such as
corticosteroids or other immunosuppressive drugs required for
a total duration of six weeks or more, but not constantly
during the past year. See 67 Fed. Reg. At 49,596 (2002).
For the next higher 60 percent disability evaluation, there
must be dermatitis or eczema over more than 40 percent of the
entire body or more than 40 percent of the exposed areas
affected, or; constant or near-constant systemic therapy such
as corticosteroids or other immunosuppressive drugs for the
past 12 month period. Id. There is no higher disability
evaluation available under this Code.
The Board has carefully reviewed the evidence of record, as
summarized above, and finds that for the reasons and bases
set forth below, the veteran's skin disorder most closely
approximates the criteria for a 50 percent disability rating
from May 16, 1994 to August 29, 2002 under the former
criteria and a 60 percent disability rating from August 30,
2002 under the current criteria. See 38 C.F.R. § 4.118,
Diagnostic Code 7806 (2001); 67 Fed. Reg. 49,590, 49,596
(2002).
Upon reviewing the former rating criteria in relation to the
evidence for consideration, the Board finds that the
veteran's disability picture is more severe than was
evaluated, and that an increased disability evaluation is
warranted. The objective medical evidence of record clearly
shows that the veteran's symptomatology has met at least some
of the criteria for a 50 percent disability evaluation from
May 16, 1994 to August 29, 2002. The veteran experienced
ulcerations and crusting, as well as hyperpigmentation,
purulent discharge, and exudation. Furthermore, the most
recent VA examiner clarified the nature of the veteran's skin
disorder, stating that the hyperpigmentation and alopecia
were systemic manifestations of the veteran's acne and
folliculitis. Likewise, the veteran had infected cysts and
scarring from cysts. In addition, the veteran had required
the near continuous use of medication, since at least 1992,
as her skin disorder was chronic, with worsening symptoms
with flare-ups. Most significantly, the VA examiner in
September 2002 stated that the veteran's scars from the
fissures and sinus tracts of her skin disorder were
exceptionally repugnant. Therefore, the Board finds that
reasonable doubt should be resolved in the veteran's favor
and concludes that the veteran's skin disorder from May 16,
1994 through August 29, 2002 more closely approximated a 50
percent disability evaluation under Diagnostic Code 7806.
Additionally, the Board finds that the veteran's dermatitis
is most consistent with a 60 percent disability evaluation
and that an increased disability evaluation is warranted upon
reviewing the current rating criteria in relation to the
veteran's symptomatology demonstrated after August 30, 2002.
The objective clinical evidence of record clearly shows that
the veteran requires near-constant systemic therapy for her
skin disorder, since at least 1996. In this regard, the
Board notes that the veteran uses steroid topical treatments
as well as antibiotics to alleviate the symptoms of her skin
disorder, without complete control. Moreover, the Board
notes that the veteran's skin disorder, during flare-ups,
encompasses a significant portion of the affected areas,
causing discomfort. Likewise, the Board notes that the
veteran had hyperpigmentation and nodules on her forehead,
cheeks, and neck, and papules and nodules on her scalp, as
well as cysts and scars on her thighs and in her vaginal and
rectal areas. As such, the Board finds that the veteran's
skin disorder from August 30, 2002 more closely approximated
a 60 percent disability evaluation under Diagnostic Code
7806.
The Board acknowledges that the veteran and her
representative requested an additional disability evaluation
for her scars. However, the Board points out that the
veteran's scarring from the cysts, ulcerations, and other
manifestations of her skin disorder were contemplated by the
aforementioned increased disability evaluations, and that an
additional disability evaluation for her scarring is not
warranted. In this regard, the Board notes that the nature,
extent, and severity of the veteran's scarring was
contemplated when granting an increased disability evaluation
for her skin disorder on the basis of exceptional repugnancy
and the need for near constant systemic therapy to treat her
skin disorder. As such, the veteran is not entitled to an
additional disability evaluation for her scars. See
38 C.F.R. § 4.14 (the evaluation of the same "disability"
or the same "manifestations" under various diagnoses is
prohibited). See also Brady v. Brown, 4 Vet. App. 203, 206
(1993) (a claimant may not be compensated twice for the same
symptomatology as "such a result would overcompensate the
claimant for the actual impairment of his earning
capacity.").
Finally, the Board has considered whether the veteran is
entitled to an increased disability evaluation on an extra-
schedular basis. However, the Board concludes that the
record does not present such "an exceptional or unusual
disability picture as to render impractical the application
of the regular rating schedule standards." 38 C.F.R.
§ 3.321(b)(1). In this regard, the Board finds that there
has been no showing by the veteran that her skin disorder,
standing alone, resulted in marked interference with
employment or necessitated frequent periods of
hospitalization so as to render impractical the application
of normal rating schedule standards. Rather, it appears that
the veteran has been treated on an outpatient basis for her
skin disorder and that the veteran's unemployment is due to
the veteran's choice, as she is a homemaker who cares for her
young son. Accordingly, the Board finds that the criteria
for submission for assignment of an extra-schedular rating
pursuant to 38 C.F.R. § 3.321(b)(1) have not been met.
ORDER
Subject to the laws and regulations governing awards of
monetary benefits, a 50 percent disability evaluation for
scalp folliculitis, acne keloidalis nuchae, and hidradenitis,
is granted for the period from May 16, 1994 to August 29,
2002, and a 60 percent disability evaluation is assigned from
August 30, 2002.
WARREN W. RICE, JR.
Member, Board of Veterans' Appeals
IMPORTANT NOTICE: We have attached a VA Form 4597 that tells
you what steps you can take if you disagree with our
decision. We are in the process of updating the form to
reflect changes in the law effective on December 27, 2001.
See the Veterans Education and Benefits Expansion Act of
2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the
meanwhile, please note these important corrections to the
advice in the form:
? These changes apply to the section entitled "Appeal to
the United States Court of Appeals for Veterans
Claims." (1) A "Notice of Disagreement filed on or
after November 18, 1988" is no longer required to
appeal to the Court. (2) You are no longer required to
file a copy of your Notice of Appeal with VA's General
Counsel.
? In the section entitled "Representation before VA,"
filing a "Notice of Disagreement with respect to the
claim on or after November 18, 1988" is no longer a
condition for an attorney-at-law or a VA accredited
agent to charge you a fee for representing you.